Healthcare Provider Details

I. General information

NPI: 1659934412
Provider Name (Legal Business Name): WENDY CRISTINA PERDOMO PENA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 HOSPITAL DR STE 450
MOUNTAIN VIEW CA
94040-4171
US

IV. Provider business mailing address

2495 HOSPITAL DR STE 450
MOUNTAIN VIEW CA
94040-4171
US

V. Phone/Fax

Practice location:
  • Phone: 408-871-3400
  • Fax:
Mailing address:
  • Phone: 408-871-3400
  • Fax: 650-643-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT229747
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number72296
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA201213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: